Is Workers Comp a Gateway to Opioid Abuse?

In a study published last October in JAMA Network, researchers found that that an alarming number of workers compensation beneficiaries become persistent users of opioids. Of the nearly 9,600 workers comp claims the researchers examined, over 30 percent showed that the injured worker had filled at least one prescription for opioid painkillers 90 days or more after the injury occurred. And ten percent of injured workers filled an opioid prescription at least one year after the injury occurred..  

Most alarmingly, the injuries many of these persistent opioid users sustained were relatively minor muscle strains or sprains.

“The increased likelihood of persistent opioid use among strain and sprain injuries is potentially concerning, particularly given the limited evidence to support opioid therapy for these injuries,” said Nathan O’Hara, research associate at the University of Maryland School of Medicine’s in Baltimore and the lead author of the study.

Other types of workers comp claims for which opioids were prescribed were crush injuries, chronic joint pain and chronic back pain, the study showed. However, persistent opioid use didn’t correlate with injury severity, the researchers explained. Instead, older workers; those earning more than $60,000 a year at the time of the injury; and those who were eventually deemed totally, permanently disabled were most likely to take opioids for a longer period of time.

Long Term Opioid Use And Addiction Risk

The major concern about persistent opioid use is that it has been linked to opioid abuse disorder and addiction to illicit drugs. As Mayo Clinic explains, people who use opioids for even a relatively short period of time may develop a tolerance to the medication and require larger and larger doses to achieve the same effect. But the opioid crisis has caused doctors to severely curtail their prescribing practices, forcing some long-term prescription opioid users to turn to street drugs such as heroin and fentanyl. And the results have been devastating.  According to the National Institute on Drug Abuse, fentanyl and its analogs (synthetic opioids) accounted for 30,000 opioid-related deaths in 2017.

Less concerning on a social level but still relevant for employers is the fact that persistent opioid use is associated with more costly and longer duration workers compensation claims.

A New Treatment Paradigm

Particularly given the lack of correlation between injury severity and long-term opioid use, this study points to a need for workers comp doctors to rethink their prescribing practices for workers injured on the job. Opioids are rarely necessary for minor injuries, and may have limited efficacy in the treatment of chronic pain. In fact, according to Lindsey Vuolo, associate director for health law and policy at the Center on Addiction, a New York based nonprofit that is working to find solutions to the opioid crisis in the U.S., opioids should never be first-line treatment for persistent pain. Non-opioid painkillers and other interventions, such as physical therapy and other non-pharmacologic treatments, should always be tried first.

Dr. Jianguo Cheng, director of the multidisciplinary pain medicine program at the Cleveland Clinic and president of the American Academy of Pain Medicine, agrees. Doctors need to stop prescribing opioids as the first line treatment for relatively minor injuries, he said.  Most importantly, workers comp doctors should carefully evaluate each patient’s progress towards treatment goals after initiating opioid therapy and adjust doses and frequency accordingly. 

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